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Editorial

Lloyd, J., and Pollard, R., 2014. Editorial. Reformulation, Summer, pp.3-4.

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This edition is a special issue with a focus on CAT and people with disabilities. The timing of this issue reflects the publication of a book on CAT and people with intellectual disabilities and their carers. Of course we acknowledge the coherence of interest here with the editorial team, as Julie currently chairs the CAT learning disability special interest group and is co-editor of the book, but we both believe that the importance of these issues for all CAT therapists is reflected in the high quality of the articles in this issue and their relevance for all areas of therapeutic work.

Of the articles, five are about working with people with learning disabilities, one with acquired brain injury, one describing family work with a child with specific language deficits and one addressing how CAT can be used to help people with chronic pain. We were surprised that we did not receive more submissions from CAT therapists working with people with physical disabilities: Given the way that services are configured, it is likely that many CAT therapists are more likely to work with someone with a physical disability than with a significant learning disability. So we wondered, does this reflect areas of CAT practice that are yet to be developed? Are there, for example, CAT therapists with the expertise to work with people with sight or hearing disabilities? We also wondered how clients view the therapist who has an obvious disability, and what people’s experience is of how having a disability affects them as a therapist? Just as a pregnant therapist can elicit transference feelings, a therapist with an obvious disability is likely to do the same. This of course is closely related to how therapists and their clients manage the situation when the therapist or client falls ill, particularly if the illness is terminal and leads to premature endings. The sensitivity or lack of it with which these situations are handled can have profound effects on clients and therapists alike.

Disability potentially affects us all whether we are currently disabled or not. It can be a lifelong experience, or a temporary experience as a result of illness or accident, or a permanent outcome of these. Despite the arbitrary delineations between being able bodied and intellectually able and fit for work and being disabled and unfit for work drawn by the DWP, physical and intellectual disability and ability are not discrete fixed entities but fluctuate along a continuum. And most of us are likely at some stage in our lives to be caring for someone with a physical or intellectual disability.

We imagine that at this point many of you will have noticed the swinging between “learning” and “intellectual” disability, which expresses the endless search for an idyllic term that would make everyone feel comfortable. Those of you who work in mainstream services might wonder why therapists working in learning disability services are so passionate about their work. Perhaps it is that, like the client group they work with, they have often felt silenced and marginalised in the wider therapeutic community. However, far more importantly, there is substantial evidence that “ordinary” things that are implicated in the development of emotional distress and subsequent mental health difficulties in the general population happen more often to people with learning and other disabilities. For example, as ACAT member Hilary Brown describes, people with intellectual disabilities tend to suffer multiple separations and abandonments, have a higher than usual incidence of sexual abuse and/ or neglect, and their varying needs for independence and dependence are often poorly assessed and met. As recent serious case reviews demonstrate, accessing appropriate health care services remains a critical issue for many people with learning disabilities.

People with physical and intellectual disabilities and their families and carers are also suffering hugely because of the cumulative impact of government cuts to benefits and services. The notorious ATOS assessments are also contributing to the demonization of people with long -term health problems as being either fraudulent or burdens on the rest of society. The recent report into the preventable death of Connor Sparrowhawk, an 18 year old with autism, a learning disability and epilepsy at Slade Hall Assessment unit in July last year also shows that the lessons from Winterbourne View have yet to be learned (http://www.southernhealth.nhs.uk/news/report-into-death-sparrowhawk/).

Despite all the gloom, however, there are signs of hope as people with intellectual disabilities and their carers are taking the initiative and fi ghting back against social exclusion and discrimination. “Constant Flux” is a new organisation bringing heavy metal and punk bands with musicians who have learning disabilities such as “Zombie Crash”, “Fish Police” and the Finnish Band “Pertii Kurikan Nimipaivat” to mainstream audiences in the UK that can give voice to some of the anger and frustration:

Why don’t you understand me? You always torture me, Force me to clean toilets, Force me to eat, I don’t understand why you don’t let me outside. I don’t want to live in a group home, I don’t want institution, I want respect.

In the words of Barbara Perry writing on the Guardian’s comments page in response to the report into the death of Connor Sparrowhawk:

As awareness increases and society ceases infantilising, pathologising, stigmatising and dehumanising physical and cognitive difference, perhaps we will support an increased level of investment in individuals who are often more than capable of becoming functional, contributing members of our society. (http://www.theguardian.com/society/2014/mar/19/connor-sparrowhawk-death-nhs-residential-unit-fight-justice)

As a radical social model, CAT may particularly attract workers whose empathy and curiosity is focused on those who are most socially and economically excluded; people with disabilities. Writing in Reformulation is one way of seeking to give a voice to those who are so often silenced. We also hope that these articles show that working with people with disabilities does not require the therapist to be “special” in any way. By showing how ordinary this work is, we hope that more CAT therapists in mainstream work will feel confident to uphold their awareness of the efficacy of healthy relationships in reducing psychological distress and offer the therapeutic chair to those whose disabilities are so often used to exclude.

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This is the first issue of Reformulation to be peer reviewed. Our aim is to continue to promote high standards of writing whilst maintaining the tradition of encouraging non-conformist and radical contributions. A major limitation of Reformulation at present is that it is not available on-line to non-ACAT members or subscribers. This means that the articles in Reformulation are not available to the wider therapy, academic and international community, making it difficult for people to learn about and research CAT. We hope to have an on-line version of Reformulation alongside the paper version in the very near future.

The Autumn 2014 issue of Reformulation will be a generic issue and we welcome articles, letters or creative writing on any topic relevant to CAT theory and practice. The deadline for submissions is 7th September 2014.

Full Reference

Lloyd, J., and Pollard, R., 2014. Editorial. Reformulation, Summer, pp.3-4.

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